Motivational Interviewing: Re-framing the issue using evidence-based “Reverse Psychology”

After hearing and reading so much about the Transtheoretical Model and the Stages of Change, I wanted to supplement Tara’s lovely presentation and this week’s readings with an exploration of motivational interviewing.  So this post will talk about how motivational interviewing is related to our readings, what exactly it is, how it’s related to public health in general and I’ll leave you with a question to ponder or discuss in the comment section.

How is this related to our readings?

Parvanta mentions motivational interviewing in the text when she differs theory-base methods (stage-based behavioral adoption) from practice strategies (motivational interviewing) and activities/channels (counseling sessions) What this means is that Motivational interviewing or MI, is an intervention that delivers an adaptation of stages of change theory to actually change an individual’s behaviour.  MI is not the only way of delivering an adaptation of the stages of change theory.  Click here to see another way to deliver a practice strategy informed by the Transtheoretical model.

What is Motivational Interviewing?

MI is an evidence-based counseling intervention that has shown to be effective in treating people with addictions issues (for those interested in the evidence here is an open access journal article full of psychology jargon about MI).

MI is used to ‘move’ people in one stage of change to another by directing the conversation in such a way so that the client (and not the clinician) is the one coming up with the reasons (motivation) to change. Like my title suggests a quick and dirty way to understand MI is that it is remarkably similar to the “reverse psychology” our parents (or at least TV parents) used on us when we were kids.

A foundational concept to MI is that people often get defensive when someone else is telling them why their behaviour is bad and they need to change it.  This results in the person putting more effort into justifying their behaviour and why they shouldn’t change than why they should. For this reason, MI places the burden of explaining why a behaviour is bad on the person who is doing it. It is argued that this allows the person to own the behaviour change and their own personal reasons for change. This ownership increases the likelihood of follow through and maintenance of the behaviour change.  MI can be compared to traditional ‘intervention’ style, which use confrontation to attempt to motivate people into changing in their problematic behaviours.

Below is a video of Dr. Bill Miller, the creator of motivational interview, talking about traditional addictions approaches, the background  and basics of MI.

This is public health course not a course in addictions. Why should I know about motivational interviewing?

MI is now being used for individual behavior change for behaviors like physical inactivity and healthy eating.  The Public Health Agency of Canada is now promoting the use of MI techniques by physicians for supporting behaviour change in their patients (as seen in the  video overview below). See their website for more videos on using MI techniques for specific behaviours (eg. physical inactivity).

A question for your consideration:

Motivational interviewing claims to be client driven but can also be portrayed as quite manipulative. What ethical considerations do you think are important to be aware of before using MI or any other change theories on the behaviour of others?

-Chelsea H.


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